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General NPI Number Information
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NPI Number | 1972704757
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Entity Type | Organization
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Legal Business Name | SAN TAN URGENT CARE HEALTH CENTER
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 21321 E OCOTILLO ROAD SUITE 118
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City | QUEEN CREEK
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State | AZ
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Zip | 85242
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Country | US
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Telephone | 480-458-5135
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Fax | 480-458-5241
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Provider Business Mailing Address
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Address Line | 21321 E OCOTILLO RD SUITE 118
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-6873
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Country | US
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Telephone | 480-458-5135
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | LISA MACK
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Credential |
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Telephone | 480-458-5135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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